title: Aspects of thermoregulation physiology.
abstract: OBJECTIVE
  The review covers the main aspects of thermoregulation physiology and highlights the implications for therapeutic hypothermia trials. Prevention of shivering and other hypothermia side-effects is of key importance because controlling thermoregulatory responses may be essential for demonstrating neuro-protective properties of hypothermia in several pathologic conditions in which its role is still uncertain, such as in traumatic brain injury and stroke.
  
  
  RESULTS
  Several recommendations and clinical reviews have been produced in the past 2 years about the application and feasibility of therapeutic hypothermia. Many drugs have been tested in healthy volunteers and anaesthetized patients to abolish shivering but the best protocol for managing side-effects has not yet been defined. A possible strategy might be to simultaneously apply physical methods, such as skin warming, and combination drug therapy. Different drug protocols can be applied, depending on the nature of the care setting.
  
  
  CONCLUSIONS
  During moderate hypothermia treatment, conducted in an intensive care environment, shivering can be treated with sedatives, opioids (meperidine in particular), and α2-agonists, combined with active skin counter-warming. However, new randomized controlled clinical trials in intensive care patients are required to improve our knowledge regarding this treatment.
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore of Rome, Rome, Italy. sara.pitoni@edu.rm.unicatt.it
authors.forename: Sara
authors.initials: S
authors.lastname: Pitoni
authors.forename: Helen L
authors.initials: HL
authors.lastname: Sinclair
authors.forename: Peter J D
authors.initials: PJ
authors.lastname: Andrews
mesh_terms: D001833:Body Temperature Regulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000150:complications; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use; D012768:Shivering / Q000187:drug effects
chemical_list: D018696:Neuroprotective Agents